Telepsychiatry

Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. The term typically describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing.[1] Telepsychiatry services can be offered through intermediary companies that partner with facilities to increase care capacities, or by individual providers or provider groups. Most commonly, telepsychiatry encounters take place at medical facilities under the supervision of onsite staff, though at-home models are becoming accepted[2] as long as they are in compliance with HIPAA standards.

One of the drivers behind telepsychiatry's growth in the United States has been a national shortage of psychiatrists, particularly in specialty areas such as child and adolescent psychiatry;[3] telepsychiatry can allow fewer doctors to serve more patients by improving utilization of the psychiatrist's time. Telepsychiatry can also make it easier for psychiatrists to treat patients in rural or under-served areas by eliminating the need for either party to travel. The most common means of insurance coverage for telehealth services among the United States is to incorporate coverage into the Medicare program. Reimbursement for Medicare-covered services must satisfy federal requirements of efficiency, economy and quality of care. Since 1999, Medicare and Medicaid reimbursement for all kinds of telehealth services have expanded, requirements of providers have been reduced, and grants have been given to support telehealth program adoption. For 2014, the Center for Medicare (CMS) services does cover telemedicine services, including telepsychiatry in many areas.

Psychiatric treatment of patients who are at home or in another private setting is called home-based telepsychiatry[4] or direct-to-consumer telepsychiatry, and it can require only a webcam and high-speed internet service. However, in order to avoid the risk of violating the patient-provider relationship, issues of security and possible HIPAA violations, providers who wish to practice in-home telepsychiatry are best served doing so from within a secure, HIPPA compliant online platform.

Individual psychiatrists are adopting this method more and more with willing, interested patients,[2] and it is an especially useful tool for consumers with limited mobility included the elderly and the disabled. Unfortunately, home-based telepsychiatry is not typically reimbursed by private payors or Medicaid, though many states are adopting measures into their legislation in the form of parity laws that would allow for it to be reimbursed in the future.

Forensic telepsychiatry is the use of a remote psychiatrist or nurse practitioner for psychiatry in a prison or correctional facility, including psychiatric assessment, medication consultation, suicide watch, pre-parole evaluations and more. Telepsychiatry can deliver significant cost savings to correctional facilities by eliminating the need for prisoners to be escorted to off-site appointments and psychiatric interventions.[6]

As of 2008, guidelines are being developed for the provision of telepsychiatric consultation for emergency psychiatric patients, such as the evaluation of suicidal, homicidal, violent, psychotic, depressed, manic, and acutely anxious patients.[7] However, emergency telepsychiatry services are already being provided to hospital emergency departments, jails, community mental health centers, substance abuse treatment facilities, and schools. Emergency telepsychiatry can ease staff shortages in overworked hospital emergency departments and increase patient throughput and ED disposition. Rather than employ expensive, short-term locum tenens doctors or have emergency department physicians evaluate the psychiatric stability of their patients, hospitals can use telepsychiatry to decrease costs and increase patient access to behavioral health evaluations by psychiatric specialists.[8]

Crisis telepsychiatry is also an efficient means of reducing the need for psychiatric boarding. Psychiatric boarding is when a mentally ill resident is detained, often in a hospital emergency department, while waiting for proper psychiatric treatment.[9] With the increased throughput offered by telepsychiatry, psychiatric consumers enjoy reduced wait times and faster access to care.

Many facilities that offer behavioral health care are turning to telepsychiatry providers to allow for an increased care capacity. With routine telepsychiatry, a consistent provider or small group of providers serve a regular caseload of consumers in previously scheduled blocks of time. Remote providers can be consulted for medication management, treatment team meetings, supervision, or to offer traditional psychiatric assessment and consultations.

Having access to remote providers allows facilities, especially those in rural areas that struggle to recruit and maintain providers, access to a greater variety of speciality care to offer their consumers.

HIPAA (the Health Insurance Portability and Accountability Act) is a United States federal law that establishes security and privacy standards for electronic medical information exchange, including telemental health services. In order to comply with HIPAA guidelines, many providers develop their own specialized videoconferencing services, since common third-party consumer solutions do not include sufficient security and privacy safeguards. There are also a growing number of HIPAA-compliant technologies available for telepsychiatry.[10]

The NHS has been slow at recognising the merits of telepsychiatry, perhaps because the regional set up of the NHS makes the provision non-location based virtual service difficult for the bureaucracy of a state owned model to implement, though there are now some NHS Mental Health Trusts such as Oxford NHS Foundation Trust who are starting to see the cost benefits and to set up services. There is a UK based group of consultant psychiatrists, Psychiatry-UK LLP, working in a chamber model, providing a national telepsychiatry service. However, though they are registered with the Care Quality Commission as a qualified provider of medical services and can be found on the NHS Choices website, they are, as yet, only seeing patients who self fund or who have suitable health insurance.